Consent and Application for Remittance of Disability Benefits to an Insurer – Québec Pension Plan

You could receive a disability pension under the QPP, but you are already receiving disability benefits from an insurance company? With this form, you are authorizing us to remit the benefits you already received to it, in whole or in part. Complete the first part of the form. Then, ask your insurance company to complete the second part.


By signing the form, you are agreeing to file an Application for Disability Benefits with Retraite Québec. Review your contract with your insurance company, because you may not be required to complete the form.

Electronic signature

An electronic signature is accepted on this form.

RRQ-004 form. Last update: November 2023.

Notice to disabled persons

This PDF document may contain barriers to accessibility. You can obtain assistance by calling us.
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